| NPI | 1184974800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: AL 33262) |
| Additional Taxonomies | 174400000X Specialist (Licence: AL 33263) |
| Enumeration Date | 2012-09-11 |
| Last Update Date | 2020-08-05 |