| NPI | 1770011090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD61224897) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT213739) |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2022-09-28 |