| NPI | 1811318389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 153460) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 153460) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 153460) | |
| Enumeration Date | 2013-12-30 |
| Last Update Date | 2023-05-18 |