| NPI | 1700884905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA G29779) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G029779) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2012-05-24 |