| NPI | 1104935014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD12580) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD00035084) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2007-07-08 |