| NPI | 1205910643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WY 7585A) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA MD-48932) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 72459) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2023-11-07 |