| NPI | 1700085263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0102202390) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2015030442) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 3400) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 68712) | |
| Enumeration Date | 2007-07-15 |
| Last Update Date | 2023-11-29 |