| NPI | 1013185115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC 36700) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX P0602) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101254223) | |
| Enumeration Date | 2008-02-12 |
| Last Update Date | 2014-09-24 |