| NPI | 1003970849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 106575) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AR R4498) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD00030874) | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2021-04-29 |