| NPI | 1316904402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: AZ 43771) |
| Additional Taxonomies | 174400000X Specialist (Licence: NE 13273) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2016-12-08 |