| NPI | 1306874144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO R1G89) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 105681) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2015-07-21 |