| NPI | 1053699918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC 52372) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 248679) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MT201635) | |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2018-08-14 |