| NPI | 1164866976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NE 30866) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A150106) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OK 29965) | |
| Enumeration Date | 2013-04-23 |
| Last Update Date | 2018-08-13 |