| NPI | 1689696072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX L8190) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NM TM2014-0133) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2020-08-06 |