| NPI | 1346292018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0600X (Licence: WA MD60209370) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 35243) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD60209370) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2012-10-09 |