| NPI | 1235123605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NM 92256) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX K2499) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2019-08-09 |