| NPI | 1205844669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD479748) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX R9275) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 15555) | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2023-02-17 |