| NPI | 1912175134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CT 62031) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 247562) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME131052) | |
| Enumeration Date | 2008-02-11 |
| Last Update Date | 2018-12-18 |