| NPI | 1154877405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA 327152) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT211980) |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2021-06-10 |