| NPI | 1194910406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 50321) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN temp 103366) |
| Enumeration Date | 2007-09-10 |
| Last Update Date | 2016-05-20 |