| NPI | 1184685802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 103939) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 04-24672) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301063006) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 90387) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME157175) | |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2022-10-06 |