| NPI | 1306075270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 69808) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 125056400) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 67120) | |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2021-08-13 |