| NPI | 1548577943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD468270) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 244739) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NH 16386) | |
| Enumeration Date | 2010-09-07 |
| Last Update Date | 2019-08-08 |