| NPI | 1083631865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VT 42-0006993) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 1763671) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2013-10-04 |