| NPI | 1093383135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA DO-06449) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA R-12236) |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2024-01-30 |