| NPI | 1538110416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: PR 15677) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: LA 024503) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME72710) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2007-07-08 |