| NPI | 1275629719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WA MD60076901) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: ND 10292) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2019-10-24 |