| NPI | 1902887185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: MA 79690) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MA 79690) |
| 208000000X Pediatrics (Licence: MA 79690) | |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2022-11-18 |