| NPI | 1396755989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NE 12605) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NE 21-2196174) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2013-02-19 |