| NPI | 1578876801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 65165) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2013034801.) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 0437671) | |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2022-09-09 |