| NPI | 1972604353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 45315) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA 00G496480) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2012-09-07 |