| NPI | 1225165657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME134941) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA L-228333) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 267884) | |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2018-06-04 |