| NPI | 1235436288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 036.140803) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 64067-20) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY R2832) | |
| Enumeration Date | 2011-02-26 |
| Last Update Date | 2022-01-26 |