| NPI | 1578930533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME132039) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL MFC1733) |
| Enumeration Date | 2015-08-26 |
| Last Update Date | 2019-05-23 |