| NPI | 1790711976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX N1754) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX N1754) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2020-06-10 |