| NPI | 1114977287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WI 49411) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WI 1407-TEP) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2023-12-01 |