| NPI | 1457520520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: SC 1400) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: PA OT010760) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: GA 060598) | |
| Enumeration Date | 2008-02-22 |
| Last Update Date | 2010-06-10 |