| NPI | 1023091477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX J1083) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME88890) |
| 174400000X Specialist | |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2021-08-12 |