| NPI | 1629415476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: IN 02004573A) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: IN 02004573A) |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2019-04-10 |