| NPI | 1225393663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2017-00931) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC LL34846) |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2017-07-06 |