| NPI | 1497811087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 273911) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: HI 13839) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2018-03-30 |