| NPI | 1770758476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CT 74604) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 002854) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NJ 25MB08971300) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD442832) | |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2023-07-06 |