| NPI | 1508124272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A2900X Psychiatry & Neurology, Neurocritical Care (Licence: TX R1322) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101254958) |
| Enumeration Date | 2012-05-01 |
| Last Update Date | 2019-08-09 |