| NPI | 1568429140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO DR.0047392) |
| Additional Taxonomies | 172A00000X Driver |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2025-03-26 |