| NPI | 1790168631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2019-00086) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA PGY.202892) |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2022-06-16 |