| NPI | 1346248614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME83438) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: TX L2902) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2017-04-26 |