NPI | 1174815997 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD450948) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT198896) |
2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MT198896) | |
Enumeration Date | 2011-05-12 |
Last Update Date | 2021-06-21 |