| NPI | 1003862582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D0079868) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DC MD043460) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101258524) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 224105) | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2021-06-06 |