| NPI | 1902149016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2017010627) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: HI 19260) |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2023-06-28 |