| NPI | 1235136003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 50247) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA MD.203511) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NV 11187) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2018-05-31 |