| NPI | 1154308112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CO 50362) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: ME 014777) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2012-09-28 |