| NPI | 1568707586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: UT 11222366-1205) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: WY 12241A) |
| Enumeration Date | 2012-12-03 |
| Last Update Date | 2021-11-19 |