| NPI | 1851547764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME116793) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125-055416) |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2013-07-11 |