| NPI | 1386999639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: WI 76367) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036141016) |
| 207R00000X Internal Medicine (Licence: MA 252141) | |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: MI 4301116556) | |
| Enumeration Date | 2012-07-23 |
| Last Update Date | 2021-12-10 |