| NPI | 1275507642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NC 33016) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TN 24407) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2016-12-06 |