| NPI | 1265882195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY 54553) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 268043) |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2021-07-26 |