| NPI | 1710477443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX T4110) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NV SL1331) |
| Enumeration Date | 2018-05-17 |
| Last Update Date | 2024-06-21 |