| NPI | 1740256502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: IA 30503) |
| Additional Taxonomies | 174400000X Specialist (Licence: IA 30503) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2016-05-05 |