| NPI | 1528017324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: TX H5053) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX H5053) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2011-01-24 |