| NPI | 1528556446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 64456) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA pending) |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2023-10-02 |