| NPI | 1144585340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2017020532) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 253251) |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2018-02-21 |