| NPI | 1275515918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: OR MD173687) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: CT 043292) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2020-10-15 |