| NPI | 1275744526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 290354) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 290354) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2023-09-04 |