| NPI | 1669821658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA OP61158215) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: RI LP03778) |
| 207R00000X Internal Medicine (Licence: RI LP03778) | |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2026-04-29 |