| NPI | 1912312919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0102205979) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL OS1776) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NH 18974) | |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2020-03-04 |