| NPI | 1740410117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY TP299) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT013039) |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2019-03-13 |