| NPI | 1063599157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 55288) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 200300104) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC MD26596) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SD 5436) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2017-10-10 |