| NPI | 1174663496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AL 21599) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 71658) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 2065-320) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2022-07-20 |