| NPI | 1336182260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 52025) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 52025) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2016-08-03 |