| NPI | 1093873754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME105032) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX E6717) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2009-10-20 |