| NPI | 1194955542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX Q1856) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 49055) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 142419) | |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2020-03-13 |