| NPI | 1851381776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: AZ 37644) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MN 39978) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ME80405) | |
| Enumeration Date | 2005-10-22 |
| Last Update Date | 2020-08-03 |