| NPI | 1205990256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD445541) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D0058359) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DC MDD30059) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101055431) | |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2013-05-14 |