| NPI | 1851738702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD462116) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN19079) |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2020-10-12 |