| NPI | 1215954201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: ND 3760) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: MN 19797) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2011-12-29 |