| NPI | 1194132597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 59666) |
| Additional Taxonomies | 2084P0805X (Licence: MN 59666) |
| Enumeration Date | 2014-07-17 |
| Last Update Date | 2025-11-17 |