| NPI | 1740600980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MT205739) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT205739) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD464751) | |
| Enumeration Date | 2014-04-25 |
| Last Update Date | 2019-07-11 |