| NPI | 1598177651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CO DR.0064899) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX R4618) |
| Enumeration Date | 2014-05-23 |
| Last Update Date | 2021-06-21 |