| NPI | 1346682861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA 62531) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101271446) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 82847) | |
| Enumeration Date | 2013-07-25 |
| Last Update Date | 2023-10-31 |