| NPI | 1518073915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD014012E) |
| Additional Taxonomies | 2084P0805X (Licence: PA MD014012E) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2019-01-22 |