| NPI | 1356535991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NC 9901332) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: AR E-13871) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: MS 28252) | |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: TN 62488) | |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WV 30134) | |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2022-04-07 |