| NPI | 1881189645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301512062) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT215265) |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2024-07-17 |