| NPI | 1053453928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO DR.0047063) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NE 20695) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO 47063) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2022-04-08 |