| NPI | 1316953243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA G53135) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G53135) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2016-10-31 |