| NPI | 1447212147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: NY 208664) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 208664) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2021-04-02 |