| 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 |