| NPI | 1508215195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2020-02531) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC MD39684) |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2020-07-23 |