| NPI | 1639253982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084B0040X Psychiatry & Neurology Behavioral Neurology & Neuropsychiatry (Licence: MO 2008004262) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MO 2008004262) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: MO 2008004262) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2023-08-10 |