| NPI | 1316369523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: SD 10973) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: OH 57.023409) |
| Enumeration Date | 2014-01-08 |
| Last Update Date | 2018-12-05 |