| NPI | 1700997707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084D0003X (Licence: FL ME095705) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2005027549) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-11-03 |