| NPI | 1609960392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 243151) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO T2005013478) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2012-01-23 |