| NPI | 1336135649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 71970) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 71970) |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2026-06-21 |