| NPI | 1750526182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0600X (Licence: TX P2322) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX P2322) |
| Enumeration Date | 2008-12-15 |
| Last Update Date | 2025-10-16 |