| NPI | 1467860809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD463918) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT207332) |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2020-09-29 |