| NPI | 1306844220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0600X (Licence: MA 79586) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 79586) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2019-06-24 |