| NPI | 1881763415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA MD.204773) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101232255) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2011-11-03 |