| NPI | 1003820291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 76623) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: GA 76623) |
| 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry (Licence: NM MD-2008-0223) | |
| 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry (Licence: GA 76623) | |
| 2084P0301X Psychiatry & Neurology, Brain Injury Medicine (Licence: GA 76623) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NM MD-2008-0223) | |
| 2084P0805X (Licence: GA 76623) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2021-11-08 |