| NPI | 1861512766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SD 10467) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 53776) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301079677) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2022-07-21 |