| NPI | 1679646467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 265107) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NH 8509) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2023-01-26 |