| NPI | 1750624656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 289410) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301115993) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD481156) | |
| Enumeration Date | 2013-03-29 |
| Last Update Date | 2023-07-13 |