| NPI | 1659378826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO 43010) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NE 21289) |
| Enumeration Date | 2005-07-04 |
| Last Update Date | 2024-08-26 |