| NPI | 1861875460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NE 7551) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ND 17309) |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2022-01-13 |