| NPI | 1770574816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: GA 050798) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 050798) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2012-09-11 |