| NPI | 1972632974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101248133) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 133988) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2020-10-20 |