| NPI | 1215023262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX J4165) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NY 235150) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ME88722) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2024-07-15 |