| NPI | 1316174295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CO 52810) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MI W400440379055) |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2021-05-15 |