| NPI | 1124219050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 50282) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA Louisiana Medical) |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2017-07-07 |