| NPI | 1184658858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 64833) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2017034370) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MA07643400) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 308-320) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2019-10-14 |