| NPI | 1053662007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: AZ AP9678) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MS R860526) |
| Enumeration Date | 2012-09-29 |
| Last Update Date | 2022-07-21 |