| NPI | 1679066013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: IA DO-05653) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: IA R-11298) |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2022-08-03 |