NPI | 1649244773 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME120142) |
Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WV 16281) |
2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101280953) | |
Enumeration Date | 2006-02-15 |
Last Update Date | 2024-07-09 |