| NPI | 1750757209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD458603) |
| Additional Taxonomies | 2084A2900X Psychiatry & Neurology, Neurocritical Care (Licence: MI 4301504334) |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2023-12-13 |