| NPI | 1033770508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 310016) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 310016) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA LT000832) | |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2021-09-22 |