| NPI | 1538457510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 60146) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301098301) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: GA 073971) | |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2017-10-30 |