| NPI | 1386867711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301082621) |
| Additional Taxonomies | 2084D0003X (Licence: MI 4301082621) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2019-05-07 |