| NPI | 1962469809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 195905) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 195905) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 195905) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2019-10-24 |