| NPI | 1669881116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084A2900X Psychiatry & Neurology, Neurocritical Care (Licence: NY 290121) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 290121) |
| 282N00000X General Acute Care Hospital | |
| Enumeration Date | 2014-08-08 |
| Last Update Date | 2021-02-20 |