NPI | 1174580153 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 86861) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME108940) |
2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX M2601) | |
Enumeration Date | 2006-04-26 |
Last Update Date | 2022-04-26 |