| NPI | 1023099645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: AL 20842) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AL 20842) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2015-01-16 |