| NPI | 1720169543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 196868) |
| Additional Taxonomies | 2084D0003X (Licence: NY 196868) |
| 2084N0008X Psychiatry & Neurology, Neuromuscular Medicine (Licence: NY 196868) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2021-03-30 |