| NPI | 1033558895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX S9111) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: UT 10318440-1204) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 56729) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ID O-1042) | |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2024-08-25 |