| NPI | 1205578051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 74601) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 32475) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 32475) | |
| Enumeration Date | 2022-04-12 |
| Last Update Date | 2023-07-11 |