| NPI | 1962817619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084B0040X Psychiatry & Neurology Behavioral Neurology & Neuropsychiatry (Licence: ME MD26700) |
| Additional Taxonomies | 2084B0040X Psychiatry & Neurology Behavioral Neurology & Neuropsychiatry (Licence: IA MD-48057) |
| 2084B0040X Psychiatry & Neurology Behavioral Neurology & Neuropsychiatry (Licence: CO CDRH.0060526) | |
| 2084B0040X Psychiatry & Neurology Behavioral Neurology & Neuropsychiatry (Licence: WI 404-320) | |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: WI 404) | |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WI 404-320) | |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2023-02-24 |