| NPI | 1013534809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: PA MD488493) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: NJ 25MA12721300) |
| Enumeration Date | 2020-06-29 |
| Last Update Date | 2025-07-01 |