| NPI | 1053935049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MN 72704) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: IA R-11843) |
| Enumeration Date | 2020-06-04 |
| Last Update Date | 2024-09-19 |