| NPI | 1558709170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX R4178) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: RI lp02866) |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2018-01-29 |