| NPI | 1003078692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME160057) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: TX N2757) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2023-01-04 |