| NPI | 1063554038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MO 105501) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MO MDR105501) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2022-05-02 |