| NPI | 1336302058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 24759) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 064858) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 53216020) | |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2013-08-15 |