| NPI | 1699724450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: FL ME0071317) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME71317) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME0071317) | |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2012-11-05 |