| NPI | 1396238176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: RI MD18719) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CT 73764) |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2025-02-05 |