| NPI | 1336439801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CO #DR.0054779) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NM MD-2013-0763) |
| Enumeration Date | 2011-04-18 |
| Last Update Date | 2020-08-03 |