| NPI | 1942697297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 278097) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL TRN22062) |
| Enumeration Date | 2015-04-23 |
| Last Update Date | 2020-08-25 |