| NPI | 1811939929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2001012430) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KS 04-23984) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2019-02-07 |