| NPI | 1427430370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME140449) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 264120) |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2024-07-15 |