| NPI | 1427400746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL OS20880) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT017378) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: GA 78903) | |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2024-04-01 |