| NPI | 1457607111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME144912) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 27349) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WV 27349) | |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2022-07-26 |