| NPI | 1417152042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A100322) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA MD.206966) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2023-04-28 |