| NPI | 1164710216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD464411) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 26344) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101257295) | |
| Enumeration Date | 2011-07-11 |
| Last Update Date | 2023-10-27 |