| NPI | 1760538136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NM 7256) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: NM 7256) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2007-07-08 |