| NPI | 1851377451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OK 27703) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 108947) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2010-12-21 |