| NPI | 1184625329 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME56094) | 
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101243500) | 
| Enumeration Date | 2005-08-10 | 
| Last Update Date | 2020-06-29 |