| NPI | 1336557164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 27948) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN 71433) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301511695) | |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: WV 27948) | |
| Enumeration Date | 2014-07-24 |
| Last Update Date | 2024-12-13 |