| NPI | 1770726176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 74569) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO 50553) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 56680) | |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2021-06-30 |