| NPI | 1043250848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME109869) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 0423131) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO R7C86) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2023-10-13 |