| NPI | 1164511168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME109304) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: SC 28964) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2011-06-29 |