| NPI | 1710908330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 70184) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ID M-13564) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC MD36235) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2023-01-29 |