| NPI | 1366641706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 239351) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 232383) |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2014-04-15 |