| NPI | 1194739995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME104927) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MS 08870) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2010-02-17 |