| NPI | 1154850212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MT213808) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT213808) |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2019-10-27 |