| NPI | 1891158515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: PA OS019641) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: PA OT017147) |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2020-06-20 |