| NPI | 1265424147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101236025) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: DC MD036580) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2011-08-22 |