| NPI | 1518954866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CO DR.0050668) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MO 2002012686) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2020-09-15 |