| NPI | 1083293963 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX U0656) | 
| Additional Taxonomies | 2084P0301X Psychiatry & Neurology, Brain Injury Medicine (Licence: TX U0656) | 
| Enumeration Date | 2021-04-06 | 
| Last Update Date | 2025-10-30 |