| NPI | 1689640542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: CO 46748) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: PA MD023070E) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: PA MD023070E) | |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CO 46748) | |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2018-07-26 |