| NPI | 1003260761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 304034) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 267535) |
| Enumeration Date | 2016-04-19 |
| Last Update Date | 2021-05-14 |