NPI | 1104096353 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 242670) |
Additional Taxonomies | 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry (Licence: MA 242670) |
2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 242670) | |
Enumeration Date | 2008-03-04 |
Last Update Date | 2019-11-05 |