| NPI | 1558674747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0600X (Licence: TX S2985) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX S2985) |
| Enumeration Date | 2010-07-16 |
| Last Update Date | 2019-09-27 |