| NPI | 1851770861 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CT 1.062844-RES) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301107709) | 
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MT210416) | |
| Enumeration Date | 2015-05-22 | 
| Last Update Date | 2020-09-07 |