| NPI | 1871641688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD60913179) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60913179) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA G56333) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2019-07-24 |