| NPI | 1912918194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 218322) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 218322) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2022-09-12 |