| NPI | 1710914239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: VA 0101245372) |
| Additional Taxonomies | 174400000X Specialist (Licence: ME 016027) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2010-11-29 |