| NPI | 1972009553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 315213) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 315213) |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2023-07-17 |