| NPI | 1922337476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX Q0290) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2009-12-11 |
| Last Update Date | 2022-12-30 |