| NPI | 1679530042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 55861) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN 41118) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101222168) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME125430) | |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2024-08-21 |