| NPI | 1386626026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 38279) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: MA 38279) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2007-07-08 |