| NPI | 1144486770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME127139) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: NE 25581) |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2016-08-24 |