| NPI | 1730173485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: PA MD0611259L) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD0611259L) |
| 174400000X Specialist (Licence: PA MD061259L) | |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2023-11-06 |