| NPI | 1164413159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D0088750) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY ky20046) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY ky20046) | |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2023-04-19 |