| NPI | 1972893238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD60290477) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NJ 0) |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2012-09-20 |