| NPI | 1578590873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 233772) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 219981) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2009-08-17 |