| NPI | 1316903362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101231695) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WV 21572) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2020-01-20 |