| NPI | 1003089665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 272199) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA 443872) |
| Enumeration Date | 2008-04-03 |
| Last Update Date | 2023-08-31 |