| NPI | 1922090596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: MA 253761) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: LA 11334R) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2013-01-31 |