| NPI | 1144480682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 40290) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 246626) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NJ 25MA08475600) | |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2026-05-06 |