| NPI | 1982894606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: CA A89407) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL TPME1444) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: NV 15658) | |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: WA MD61024483) | |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2024-07-17 |