| NPI | 1528473782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: UT 12099433-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 260085) |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2021-10-29 |