| NPI | 1639369366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: GA 67989) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX Q9025) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD 437373) | |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2016-08-14 |