| NPI | 1073719084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME124152) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PR 16476) |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2015-09-09 |