| NPI | 1982832960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0301X Psychiatry & Neurology Brain Injury Medicine (Licence: VA 0101036956) |
| Additional Taxonomies | 2084B0040X Psychiatry & Neurology Behavioral Neurology & Neuropsychiatry (Licence: VA 0101036956) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: VA 0101036956) | |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2017-03-27 |