| NPI | 1750347878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA 020998) |
| Additional Taxonomies | 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry (Licence: LA 020998) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA 020998) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2021-11-16 |