| NPI | 1891779872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 34762) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A88539) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2011-04-15 |