| NPI | 1093783334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME72814) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME72814) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: GA 044099) | |
| Enumeration Date | 2006-03-11 |
| Last Update Date | 2009-07-28 |