| NPI | 1508170820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 286152) |
| Additional Taxonomies | 2084N0600X (Licence: AL MD32966) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: RI MD20174) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NH 17423) | |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2025-09-29 |