| NPI | 1902996796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: NJ MA63918) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: PA MD058062L) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2016-04-22 |