| NPI | 1851488423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA 41696) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD21774) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2021-11-05 |