| NPI | 1831454644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX S0852) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: OH ACKNOWLEDGMENT LETTE) |
| Enumeration Date | 2012-07-08 |
| Last Update Date | 2023-01-09 |