| NPI | 1538190202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: PA MD-015-305-E) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX E5143) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2007-07-11 |