| NPI | 1053549832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ME110832) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: AL MD.31852) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2022-09-12 |