| NPI | 1265525372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2012-01542) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 45189) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2021-06-11 |