| NPI | 1578528865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA OS003976L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS003976L) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2016-06-07 |