| NPI | 1891729125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME82190) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME82190) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2012-03-26 |