| NPI | 1962509067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA 20A5069) |
| Additional Taxonomies | 2084N0600X Psychiatry & Neurology, Clinical Neurophysiology (Licence: CA 20A5069) |
| 2084S0010X Psychiatry & Neurology, Sports Medicine (Licence: CA 20A5069) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2015-05-15 |