| NPI | 1386616308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: TX N4948) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: AL 26089) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2023-09-12 |