| NPI | 1518982651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MI 4301055532) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI SN05532) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2020-07-10 |