| NPI | 1104036631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD60240047) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 53335-20) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 5465497134) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2019-12-13 |