| NPI | 1730182213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: TX F7939) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: AZ 11801) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: NY 125775) | |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2011-10-05 |