| NPI | 1750839148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PR 19413) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MS 31033) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL 153661) | |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2022-12-30 |