| NPI | 1174595359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: AL L3025DP) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: WI 46025) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2011-09-26 |