| NPI | 1053873182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 322186) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CO DR.0070803) |
| Enumeration Date | 2019-04-06 |
| Last Update Date | 2025-07-11 |