| NPI | 1396721460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 9400173) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX H4795) |
| 174400000X Specialist (Licence: TX H4795) | |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2018-01-16 |