| NPI | 1821036500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: TX R1074) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: MO 2004029825) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2021-01-27 |