| NPI | 1255781720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 67125) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 39786) |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2020-08-05 |