| NPI | 1417949751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: SC 21116) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: NC 35573) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2021-09-30 |