| NPI | 1407017882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: ND PT 12718) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME104626) |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2021-02-14 |