| NPI | 1669622908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 250918) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 20088018700) |
| Enumeration Date | 2008-09-23 |
| Last Update Date | 2014-10-02 |