| NPI | 1134362288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME120950) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: NC 2013-00531) |
| Enumeration Date | 2009-04-18 |
| Last Update Date | 2021-01-29 |