| NPI | 1447645411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MS 25275) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO DR0059854) |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2025-01-31 |