| NPI | 1104989524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: OR FE153656) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: MO 2007019156) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2010-12-02 |