| NPI | 1376771600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD447574) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: PA MT196024) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MT196024) | |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2021-09-27 |