| NPI | 1205825692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CO 54909) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: DC DO32854) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX M2532) | |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2015-08-28 |