| NPI | 1154609485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME150378) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: KY 48961) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: MA 263748) | |
| Enumeration Date | 2011-08-03 |
| Last Update Date | 2021-06-21 |