| NPI | 1891172557 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NH 20516) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 264573) | 
| Enumeration Date | 2015-05-01 | 
| Last Update Date | 2020-06-08 |