| NPI | 1588070312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME151242) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 94-08356) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX T9252) | |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2023-06-09 |