| NPI | 1396170601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0600X (Licence: FL ME135763) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 018577) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: KS 04-40017) | |
| Enumeration Date | 2013-09-05 |
| Last Update Date | 2025-10-01 |