| NPI | 1013167170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME121826) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DC MD038640) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301099898) | |
| Enumeration Date | 2008-09-25 |
| Last Update Date | 2020-10-08 |