| NPI | 1629464961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: NJ 25MA10618600) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT208993) |
| Enumeration Date | 2015-04-14 |
| Last Update Date | 2019-07-12 |