| NPI | 1508192881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 12374-I) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 276081) |
| Enumeration Date | 2009-10-21 |
| Last Update Date | 2014-11-30 |