| NPI | 1730178419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: GA 29590) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC 17836) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC 17836) | |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2020-12-07 |