| NPI | 1386854974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: WA MD60170989) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: OR MD28304) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2015-04-17 |