| NPI | 1497193080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2017-01150) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT204492) |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2021-09-17 |