| NPI | 1972180131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 4301510896) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301510896) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301510896) | |
| Enumeration Date | 2021-03-25 |
| Last Update Date | 2024-03-17 |