| NPI | 1477570356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: NY 123796) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: CT 018782) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2016-01-20 |