NPI | 1578637567 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO MDR9140) |
Additional Taxonomies | 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry (Licence: MO MDR9140) |
Enumeration Date | 2006-11-20 |
Last Update Date | 2023-01-04 |