| NPI | 1104879659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA MD.024030) |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2021-08-20 |