| NPI | 1710968102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MT 132365) |
| Additional Taxonomies | 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: MD D47001) |
| 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: MT 132365) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD218378) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO 0068985) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD60441053) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ND 20638) | |
| Enumeration Date | 2005-11-11 |
| Last Update Date | 2025-01-14 |