| NPI | 1972867943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: NE 29891) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: MN 56685) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2017-07-14 |