| NPI | 1629051123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 106623) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101278113) |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2023-05-12 |