| NPI | 1902892904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC 19324) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 192745) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2006-00088) | |
| Enumeration Date | 2005-09-25 |
| Last Update Date | 2023-02-01 |