| NPI | 1386903359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: ID M-15021) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX R7892) |
| Enumeration Date | 2012-05-11 |
| Last Update Date | 2020-07-24 |