| NPI | 1801958202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: NY 150028) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: NY 150028) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2017-02-14 |