| NPI | 1275530974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX L2280) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 215469-1) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD16094) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2015-01-26 |