| NPI | 1841575032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: UT 94171671204) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 006004) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: UT 9417167-1204) | |
| Enumeration Date | 2011-10-19 |
| Last Update Date | 2021-09-09 |