| NPI | 1184739757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: NY 325426) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: CA A73986) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2024-10-01 |