| NPI | 1386933158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX T0629) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0102207171) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL OS12201) | |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2024-03-14 |