| NPI | 1164451563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 044581) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2013-00945) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ME 015839) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2018-11-07 |