| NPI | 1558712992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 287713) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 267494) |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2021-05-07 |