| NPI | 1104138122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 138595-1) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: DE C1-0003450) |
| Enumeration Date | 2010-07-07 |
| Last Update Date | 2010-07-07 |