| NPI | 1679820781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX Q8854) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 3835-320) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 036.167989) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO CDR0003485) | |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2025-09-17 |