| NPI | 1497819932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 235330) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: NY 235330) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2022-09-12 |