| NPI | 1558566471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: NJ 25MA08860900) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: NY 259005) |
| 2084N0600X Psychiatry & Neurology Clinical Neurophysiology (Licence: NY 259005) | |
| 2084N0600X Psychiatry & Neurology Clinical Neurophysiology (Licence: NJ 25MA08860900) | |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2023-03-07 |