| NPI | 1871097840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 22982) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN26206) |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2023-01-30 |