| NPI | 1003969684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD60441119) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD26712) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 52566) | |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2014-06-05 |