| NPI | 1417307380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2019024574) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2016016406) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX T0317) | |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2021-06-15 |