| NPI | 1851518138 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NE 26303)  | 
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 244424)  | 
| Enumeration Date | 2007-04-19 | 
| Last Update Date | 2011-08-04 |