| NPI | 1912914318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VT 42-0009608) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 2227961) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2007-07-08 |