| NPI | 1184184764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 319274) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 295358) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL 158625) | |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2024-04-10 |