| NPI | 1790817286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MI 4301506246) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ME76676) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WI 21761-875) | |
| Enumeration Date | 2007-03-10 |
| Last Update Date | 2022-03-16 |