| NPI | 1003302670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084E0001X (Licence: NJ 25MB11831000) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: NJ 25MB11831000) |
| Enumeration Date | 2018-07-07 |
| Last Update Date | 2023-12-11 |