| NPI | 1508958521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY 43103) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: GA 069361) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MS 22378) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2018-03-22 |