| NPI | 1356341556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NJ 25MB04815900) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA OS-005115-L) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2013-02-19 |