| NPI | 1912947086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: UT 173744-1205) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: UT 173744-1205) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2021-11-16 |