| NPI | 1841545142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 1017872) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 253083) |
| Enumeration Date | 2012-07-23 |
| Last Update Date | 2024-07-24 |