| NPI | 1699115097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: PA MD479146) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: NY 311937) |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2022-12-22 |