| NPI | 1215179254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101255421) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301085030) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301085030) | |
| Enumeration Date | 2009-04-06 |
| Last Update Date | 2020-11-07 |