| NPI | 1598151284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301116943) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10052638) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX BP20057968) | |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2020-04-23 |