| NPI | 1104204502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 306298) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP03445) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: RI LP03445) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY TP101) | |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2024-04-08 |