| NPI | 1881660322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 42900) |
| Additional Taxonomies | 208800000X Urology (Licence: MA 42900) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2009-06-23 |