| NPI | 1194060129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 85783) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX Q7817) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME128215) | |
| Enumeration Date | 2012-12-03 |
| Last Update Date | 2021-01-15 |