| NPI | 1689757189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX K9823) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: TX K9823) | |
| 2084N0600X Psychiatry & Neurology, Clinical Neurophysiology (Licence: TX K9823) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX K9823) | |
| 2084S0012X Psychiatry & Neurology, Sleep Medicine (Licence: TX K9823) | |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2022-02-15 |