| NPI | 1548355779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME140304) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: PA MD423347) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2019-12-11 |