| NPI | 1902996572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 238370) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AR E-4231) |
| 2084P0805X (Licence: AR E-4231) | |
| 2084P0805X (Licence: MA 238370) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2021-10-27 |