| NPI | 1114938404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301102124) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 241282) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NJ 25MA08715100) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2016-10-25 |