| NPI | 1962403774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry (Licence: CA C130554) |
| Additional Taxonomies | 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry (Licence: CO 36158) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO 36158) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C130554) | |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2021-11-15 |