| NPI | 1609843655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0600X (Licence: TX N4871) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX N4871) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OK 11431) | |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2018-07-16 |