| NPI | 1912137985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 58461) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA ML60093624) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME130279) | |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2019-11-04 |