| NPI | 1780671503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME74191) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TN MD23998) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2018-10-31 |