| NPI | 1487819744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX R5792) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN 47582) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101251696) | |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2018-08-10 |