| NPI | 1902849102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MO R7G24) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: KS 20645) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NC 2020-03133) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2021-09-10 |