| NPI | 1093758823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CO 52356) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MD d45101) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2014-02-04 |