| NPI | 1467879619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD184630) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA R-10040) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 78412) | |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2025-05-16 |