| NPI | 1710240403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084A2900X Psychiatry & Neurology, Neurocritical Care (Licence: MI 4301108064) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301108064) |
| 207R00000X Internal Medicine (Licence: PA MT202650) | |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2020-01-15 |