| NPI | 1093005639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SD 13010) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX U3421) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ND 13109) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 036164237) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 56998) | |
| Enumeration Date | 2011-04-16 |
| Last Update Date | 2023-11-21 |