| NPI | 1760649594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301091816) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 1580) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MT 100317) | |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2023-03-10 |