| NPI | 1265847883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2014019451) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2015-01-15 |