| NPI | 1568596641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 199795-1) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CT 070335) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2021-01434) | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2022-10-14 |