| NPI | 1982661195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX J4019) |
| Additional Taxonomies | 174400000X Specialist (Licence: AL 00020142) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2019-11-19 |