| NPI | 1407914039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME73414) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 118439) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AR E1127) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2022-03-17 |