| NPI | 1497040703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD60565158) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125:059745) |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2018-03-17 |