| NPI | 1477879732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2010005064) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NV 18812) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 0437341) | |
| Enumeration Date | 2010-04-12 |
| Last Update Date | 2021-10-04 |