| NPI | 1235661067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD60973582) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MT MED-PHYS-LIC-92088) |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2021-03-09 |