| NPI | 1285821876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY 03254) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY IP1053) |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2012-03-01 |