| NPI | 1447395454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME137861) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TN 0000041781) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2019-02-13 |