| NPI | 1528154077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD060192L) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ ma41786) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2019-01-29 |