| NPI | 1265474795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101250018) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35074649) |
| 2084D0003X Psychiatry & Neurology, Diagnostic Neuroimaging (Licence: VA 2704) | |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2012-11-26 |