| NPI | 1215177001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 31201) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 026525) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G87269) | |
| Enumeration Date | 2009-03-06 |
| Last Update Date | 2013-04-16 |