| NPI | 1790998425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 22269) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 33037020) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101239258) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2007-07-08 |