| NPI | 1245419696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WI 68490-20) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: IA MD-39487) |
| Enumeration Date | 2007-11-01 |
| Last Update Date | 2018-08-15 |