| NPI | 1104020791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 257316) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX M6485) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35.089162) | |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2015-08-31 |