NPI | 1912996505 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0023871) |
Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CO DR.0023871) |
2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO DR.0023871) | |
Enumeration Date | 2005-10-17 |
Last Update Date | 2018-06-15 |