| NPI | 1104039882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 47568) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: GA RTP000971) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2020-09-08 |