| NPI | 1205871241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA 33598) |
| Additional Taxonomies | 2084H0002X (Licence: WA 33598) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2016-06-20 |