| NPI | 1366444341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 28930) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 28930) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2013-05-01 |