| NPI | 1124327903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: WA OP61226671) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: NE 958) |
| Enumeration Date | 2011-03-20 |
| Last Update Date | 2023-05-21 |