| NPI | 1730748542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC 82659) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 82659) |
| Enumeration Date | 2019-06-06 |
| Last Update Date | 2019-06-06 |