| NPI | 1366435661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101251196) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: IA 32437) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2021-10-01 |