| NPI | 1467849323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY R6864) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN 0000033276) |
| Enumeration Date | 2015-04-18 |
| Last Update Date | 2026-01-04 |