| NPI | 1497862254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A54396) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A54396) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2011-08-05 |