| NPI | 1992124416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 294177) |
| Additional Taxonomies | 2084N0600X (Licence: NY 294177) |
| Enumeration Date | 2014-04-11 |
| Last Update Date | 2026-06-23 |