| NPI | 1962842567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 288504) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: RI DO00905) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 288696-1) | |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2024-11-08 |