| NPI | 1578213823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301511844) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX V3293) |
| Enumeration Date | 2022-03-28 |
| Last Update Date | 2025-08-11 |