| NPI | 1962081901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: PA OT021838) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MN 31595) |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2023-05-17 |