| NPI | 1548207764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 81576) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: ME MD15135) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2017-05-18 |