| NPI | 1467865790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX R5901) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX R5901) |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2019-05-30 |