| NPI | 1699716936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: ID M8099) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: WA MD60070552) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2015-08-24 |