| NPI | 1154858678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME141668) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN25340) |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2021-05-12 |