| NPI | 1972947661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC 36005) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC Ll36005) |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2021-06-07 |