| NPI | 1639668759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 318569) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 318569) |
| Enumeration Date | 2018-05-03 |
| Last Update Date | 2023-07-17 |