| NPI | 1003903154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX R6184) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CO 43400) |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2018-05-15 |