| NPI | 1578779898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 064414) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301094470) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MT185687) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2020-08-05 |