| NPI | 1669764924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: OR MD176896) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: ID MC-1643) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: WA MD60688707) | |
| Enumeration Date | 2011-05-05 |
| Last Update Date | 2022-12-23 |