| NPI | 1750775664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 73934) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: UT 10092325-1205) |
| Enumeration Date | 2015-03-28 |
| Last Update Date | 2024-09-17 |