| NPI | 1740543784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A162063) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD458752) |
| 207R00000X Internal Medicine (Licence: PA mt201945) | |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2023-02-17 |