| NPI | 1467432625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 169005) |
| Additional Taxonomies | 2084N0600X (Licence: NY 169005) |
| Enumeration Date | 2006-01-21 |
| Last Update Date | 2019-06-21 |