| NPI | 1912972845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX H7594) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A51544) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OK 20622) | |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2015-05-14 |