| NPI | 1457411944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME107776) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101268316) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 50793-020) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2020-01-22 |