| NPI | 1851886782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 52045) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL52045) |
| Enumeration Date | 2018-06-23 |
| Last Update Date | 2024-03-21 |