| NPI | 1790932119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 241654) |
| Additional Taxonomies | 2084H0002X (Licence: NY 241654) |
| 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: NY 241654) | |
| Enumeration Date | 2008-08-27 |
| Last Update Date | 2020-08-12 |