| NPI | 1922021690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MI 5101027694) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: VA 0102037168) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2024-02-01 |