| NPI | 1508111808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084B0040X Psychiatry & Neurology Behavioral Neurology & Neuropsychiatry (Licence: TX Q6946) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: TX Q6946) |
| Enumeration Date | 2012-07-23 |
| Last Update Date | 2017-09-20 |