| NPI | 1134350069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301094737) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NV 21679) |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2022-04-27 |