| NPI | 1669797627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301109221) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SD 10170) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 55848) | |
| Enumeration Date | 2010-04-02 |
| Last Update Date | 2021-02-05 |