| NPI | 1225117799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IA 086078) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: UT 6053985-2501) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2017-05-10 |