| NPI | 1417920604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 156720) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 156720) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2023-03-30 |