| NPI | 1831142702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 64693) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2005-01924) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 20037) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2021-10-04 |