| NPI | 1912124983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: VA 0101248683) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: MD D0065670) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2012-05-21 |