| NPI | 1780773465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME106727) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN10013) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2021-12-12 |