| NPI | 1811136187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 249199) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 243554) |
| Enumeration Date | 2009-02-10 |
| Last Update Date | 2023-06-12 |