| NPI | 1881699742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA 036104E) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: UT 31777651205) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G85129) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2023-09-06 |