| NPI | 1558350744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME22655) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME0022655) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2012-09-06 |