| NPI | 1194008979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: UT 2885471-1205) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NV LL3127) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME157262) | |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MO 2023044568) | |
| Enumeration Date | 2011-09-27 |
| Last Update Date | 2024-04-18 |