| NPI | 1861786246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CO DR.0057370) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 91-321) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL OS11900) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 5101024416) | |
| Enumeration Date | 2011-06-03 |
| Last Update Date | 2023-12-27 |