| NPI | 1568668176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX U6868) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DC MD038370) |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2023-10-26 |