| NPI | 1497893614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 34121) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VT 060-0003394) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2012-00252) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2012-00252) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2024-06-27 |