| NPI | 1326097262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TN 57207) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 2005-00711) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2005-00711) | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2023-02-27 |