| NPI | 1972898245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX BP10039128) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: GA 53945) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WV 24288) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MD D71738) | |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2011-06-15 |