| NPI | 1912003781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY 26535) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 26535) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2017-06-28 |