| NPI | 1417226200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: TX P1579) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX P1579) |
| Enumeration Date | 2011-12-22 |
| Last Update Date | 2020-06-22 |