NPI | 1689105843 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL OS17844) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2022019519) |
2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA OT017753) | |
Enumeration Date | 2017-03-21 |
Last Update Date | 2024-04-18 |