| NPI | 1790858413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A40273) |
| Additional Taxonomies | 174400000X Specialist (Licence: A040273) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2026-05-27 |