| NPI | 1780832774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 279000) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME109864) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD444947) | |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2015-09-03 |