| NPI | 1467560029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX H6405) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101273994) |
| 208VP0000X (Licence: TX H6405) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2022-08-25 |