| NPI | 1376776153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 270440) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MA 241152) |
| Enumeration Date | 2009-08-27 |
| Last Update Date | 2018-08-17 |