| NPI | 1881686392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX L5082) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME30779) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME30779) | |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2023-06-08 |