| NPI | 1609892603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 49304) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 72160) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AK 7740) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME106677) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2020-08-13 |