| NPI | 1225021876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101233404) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD462859) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2024-04-01 |