| NPI | 1700572849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OT023287) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA OT023287) |
| Enumeration Date | 2023-04-12 |
| Last Update Date | 2024-06-18 |