| NPI | 1366478737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX M0491) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX M0941) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX M0941) | |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2022-12-25 |