| NPI | 1942250964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TN 34121) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD70028681) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD227332) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2025-09-15 |