| NPI | 1518108117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CO 48889) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CT 046125) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 246643) | |
| Enumeration Date | 2009-03-12 |
| Last Update Date | 2020-06-22 |