| NPI | 1497166425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TN 58803) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME125599) |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2019-06-04 |