| NPI | 1003913088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: SC MD38012) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: GA 026616) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2017-02-24 |