| NPI | 1639457096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 50229) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NE 6592) |
| Enumeration Date | 2011-08-02 |
| Last Update Date | 2022-04-27 |