| NPI | 1053569301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX N9892) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA md60095823) |
| Enumeration Date | 2008-08-28 |
| Last Update Date | 2011-12-02 |