| NPI | 1255627667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME125442) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL33804) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL TRN17458) | |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2016-05-19 |