| NPI | 1790212603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2021-01033) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 7180-851) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 7147021) | |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2022-06-10 |