| NPI | 1639220379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: TX K3711) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX K3711) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2015-02-10 |