| NPI | 1487636999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC 51877) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 9800359) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2026-06-08 |