| NPI | 1811927114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2015008268) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX L3965) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2015-11-19 |