| NPI | 1073571022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ND 16458) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ND PT16458) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 154425) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 34729) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2020-09-28 |