| NPI | 1568660090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME97136) |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2022-01-10 |