| NPI | 1528407459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: OR DO197041) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: GA RTP 006120) |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2021-06-18 |