| NPI | 1780601286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A45059) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX N0728) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2013-01-24 |