| NPI | 1427011295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 41818) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 12080) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 21855) | |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2023-03-07 |