| NPI | 1225133911 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME124366) | 
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 162454) | 
| Enumeration Date | 2006-09-14 | 
| Last Update Date | 2023-05-17 |