| NPI | 1275510828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CT 64881) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 208741) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 208741-1) | |
| Enumeration Date | 2005-12-26 |
| Last Update Date | 2026-07-29 |