| NPI | 1538626262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX U4587) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MI 4704283474) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2019021249) | |
| Enumeration Date | 2019-02-28 |
| Last Update Date | 2023-08-07 |