| NPI | 1215919659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: UT 51757305-1205) |
| Additional Taxonomies | 174400000X Specialist (Licence: UT 5157305-1205) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2018-07-03 |