| NPI | 1225425754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: ID O1162) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NE 1628) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NE 7576) | |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2020-08-25 |