| NPI | 1376539791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301091116) |
| Additional Taxonomies | 174400000X Specialist (Licence: RI MD11423) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2015-04-16 |