| NPI | 1922666429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: AZ 69079) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: LA 320264) |
| Enumeration Date | 2019-05-30 |
| Last Update Date | 2023-07-07 |