| NPI | 1851654925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: RI MD16507) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CT 55318) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2019-03-18 |