| NPI | 1063623973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD436699) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA mt186349) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2012-02-02 |