| NPI | 1790942795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: NE 6200) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125052611) |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2013-03-26 |