| NPI | 1750810404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 308299) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 308299) |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2023-07-07 |