| NPI | 1649437211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: WA MD 60166620) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: NY 240196) |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2021-06-25 |