| NPI | 1669585410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: WA MD60240357) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G18317) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: UT 9259018-8017) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2016-08-02 |