| NPI | 1457515173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 55591) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OK 26300) |
| Enumeration Date | 2008-07-11 |
| Last Update Date | 2014-05-06 |