| NPI | 1467698977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD61027536) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NM MD2010-0577) |
| Enumeration Date | 2009-01-05 |
| Last Update Date | 2021-03-30 |