| NPI | 1831172816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MT 10858) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WY 6981A) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2012-08-30 |