| NPI | 1699745679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: WV 17739) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WV 17739) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2007-07-08 |