| NPI | 1164595427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME20237) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: AL 00007052) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2007-10-30 |