| NPI | 1275829269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX U3415) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2014020570) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 68752-21) | |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2023-11-09 |