| NPI | 1699813741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: GA 016261) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: VA 0101268425) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2020-01-08 |