| NPI | 1205330933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL OS18720) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL UO5991) |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2022-06-03 |