| NPI | 1518965912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: WI 40043) |
| Additional Taxonomies | 207ZN0500X Pathology Neuropathology (Licence: WI 40043) |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: WI 40043) | |
| Enumeration Date | 2005-07-09 |
| Last Update Date | 2008-07-22 |