| NPI | 1881214500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: AZ 73972) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: AZ R77959) |
| Enumeration Date | 2020-04-22 |
| Last Update Date | 2024-08-06 |