| NPI | 1124045083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AL 28844) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: ND 9269) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2013-08-28 |