| NPI | 1629049978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 3743) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 3743) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 3743) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2016-03-17 |