| NPI | 1093151813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME136592) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT204308) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: MD P30379) | |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: PA ------) | |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2022-05-02 |