| NPI | 1619381316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX S0806) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA MD-43634) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA R-10052) | |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2023-09-12 |