| NPI | 1720375025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME142779) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 245868) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2021-02-08 |