| NPI | 1942516539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO DR.0061588) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 76894) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WY 13227C) | |
| Enumeration Date | 2010-08-20 |
| Last Update Date | 2024-05-22 |