| NPI | 1477620540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CT 64469) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 158280-1) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2019-11-06 |