| NPI | 1578643466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME103592) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: VA 0101240529) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2020-09-09 |