| NPI | 1770876815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: ND 13558) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: IA R-9143) |
| Enumeration Date | 2011-05-23 |
| Last Update Date | 2020-06-08 |