| NPI | 1104077148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC MD 4932) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NM MD 2012-0064) |
| Enumeration Date | 2008-10-08 |
| Last Update Date | 2014-09-16 |