| NPI | 1811007081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AR E-13976) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NV 15030) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 056879) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2021-12-13 |