| NPI | 1104138346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084V0102X Psychiatry & Neurology, Vascular Neurology (Licence: CT 64055) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VT 060.0004408) |
| 207R00000X Internal Medicine (Licence: MA 241708) | |
| Enumeration Date | 2010-07-03 |
| Last Update Date | 2024-07-03 |