| NPI | 1659544286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: NY 267537-1) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: MO R5P79) |
| Enumeration Date | 2008-04-03 |
| Last Update Date | 2012-11-20 |