| NPI | 1295292530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 320789) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX W2242) |
| Enumeration Date | 2019-02-22 |
| Last Update Date | 2026-01-22 |