| NPI | 1467451815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2007-00146) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN 40083) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2010-03-15 |