| NPI | 1730705021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL 11007927) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9452837) |
| Enumeration Date | 2020-06-22 |
| Last Update Date | 2021-08-16 |