| NPI | 1124081237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME78169) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME78169) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2015-12-14 |