| NPI | 1154703361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 5101022725) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NV DO2563) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA OT016570) | |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2024-12-17 |