| NPI | 1013083146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 25796) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NC 25796) |
| 2084P0005X Psychiatry & Neurology, Neurodevelopmental Disabilities (Licence: NC 25796) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2014-06-09 |