| NPI | 1225698293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX U9312) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2023025116) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX U9312) | |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2024-07-30 |