| NPI | 1053460758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry (Licence: PA MD463579) |
| Additional Taxonomies | 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry (Licence: FL Me102392) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2018-03-17 |