| NPI | 1952417610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX J4683) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX J4683) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2013-08-23 |