NPI | 1417011065 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME102124) |
Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 216572-1) |
Enumeration Date | 2006-12-20 |
Last Update Date | 2014-01-07 |