| NPI | 1750530754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OK 28638) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301090833) |
| Enumeration Date | 2008-09-15 |
| Last Update Date | 2015-07-22 |