| NPI | 1467893065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NE 30007) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA 60760566) |
| Enumeration Date | 2013-07-11 |
| Last Update Date | 2019-08-07 |