| NPI | 1043598543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 307725) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2011-08-01 |
| Last Update Date | 2021-05-07 |