| NPI | 1023251139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: VA 0101233271) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: NH NH4815) |
| Enumeration Date | 2009-04-20 |
| Last Update Date | 2013-10-28 |