| NPI | 1770897050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: AR E-10505) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: NY 279941) |
| Enumeration Date | 2010-07-29 |
| Last Update Date | 2022-07-21 |