| NPI | 1639283369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CO 31129) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2013006640) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2023-01-05 |