| NPI | 1235669706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: RI LP04015) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP04015) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: ME MD25671) | |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2022-02-23 |