| NPI | 1336178433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL OS15057) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 04173) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IN 02002346A) | |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2018-10-08 |