| NPI | 1215957790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 222027) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IN 01051998A) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301093025) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2016-06-27 |