| NPI | 1093166134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 286980) |
| Additional Taxonomies | 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: MO 2019023797) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2020020814) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2016015273) | |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2021-09-03 |