| NPI | 1619462439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301115001) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301115001) |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2019-07-23 |