| NPI | 1174570311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NE 22933) |
| Additional Taxonomies | 174400000X Specialist (Licence: NE 2293) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2020-12-14 |