| NPI | 1487960332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD H71321) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD H0071321) |
| 208D00000X General Practice (Licence: MD H71321) | |
| Enumeration Date | 2010-08-28 |
| Last Update Date | 2017-02-27 |