| NPI | 1194785774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD458509) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX H6164) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2016-08-15 |