| NPI | 1245245927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD069707L) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX L2941) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2019-10-30 |