| NPI | 1922003755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: NY 135568) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: NY 135568) |
| 2084N0600X Psychiatry & Neurology Clinical Neurophysiology (Licence: NY 135568) | |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2007-07-08 |