| NPI | 1366769986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 274679) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC 83587) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2016-01110) | |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2026-03-25 |