| NPI | 1023391059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME125107) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 28753-R) |
| Enumeration Date | 2011-09-26 |
| Last Update Date | 2022-08-16 |