| NPI | 1063767051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD479976) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OK 32111) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO DR.0065269) | |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2024-03-07 |