| NPI | 1417049107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 46111) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 46111) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2013-05-09 |