| NPI | 1346805595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA T289700) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 3115) |
| Enumeration Date | 2019-05-03 |
| Last Update Date | 2021-07-24 |