| NPI | 1679768501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME 107665) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: NY 242297) |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2023-12-18 |