| NPI | 1104013325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 235887) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA a99451) |
| Enumeration Date | 2007-10-02 |
| Last Update Date | 2018-10-18 |