| NPI | 1568461986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX J5084) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: KY 30639) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2019-02-06 |