| NPI | 1710321443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ME132570) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CO DR.0071139) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: ND PT20190) | |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2024-01-16 |