| NPI | 1225055023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD60529189) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: UT 97335689-1205) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: ID M-12261) | |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2020-12-02 |