| NPI | 1467959494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD217388) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 336619-01) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: GA 92017) | |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2025-09-12 |