| NPI | 1306462643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 338595) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT221053) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: CT 78565) | |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2025-07-31 |