| NPI | 1578543260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OK 31365) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX P5364) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2015-08-11 |