| NPI | 1508133828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA G75162) |
| Additional Taxonomies | 2084N0600X (Licence: CA G75162) |
| Enumeration Date | 2011-12-01 |
| Last Update Date | 2011-12-01 |