| NPI | 1548572274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX Q8211) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2020-02281) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MS 787-L) | |
| Enumeration Date | 2010-07-10 |
| Last Update Date | 2023-10-10 |