| NPI | 1972988921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NE 31753) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NE TEP - 7567) |
| Enumeration Date | 2015-07-20 |
| Last Update Date | 2019-06-23 |