| NPI | 1053609339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD453421) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 294882) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101271747) | |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2024-08-07 |