| NPI | 1053632992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: NV DO1862) |
| Additional Taxonomies | 174400000X Specialist (Licence: NV SL0730) |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2020-11-24 |