| NPI | 1477537520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 45515) |
| Additional Taxonomies | 2084N0600X Psychiatry & Neurology, Clinical Neurophysiology (Licence: MA 45515) |
| 207R00000X Internal Medicine (Licence: MA 45515) | |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2011-08-15 |