| NPI | 1902211378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2018-00050) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 201800050) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 51476) | |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2021-03-03 |