| NPI | 1952574907 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KS 04-36541) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME113733) |
| Enumeration Date | 2008-04-10 |
| Last Update Date | 2013-08-26 |