| NPI | 1164481875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA 022555) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA 022555) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2019-10-17 |