| NPI | 1407837396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084H0002X (Licence: NY 146475) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 146475) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2021-05-06 |