| NPI | 1285620559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD490657) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101225082) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 23903) | |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2025-12-02 |