| NPI | 1215995535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 264033) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX H7677) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2021-09-02 |