| NPI | 1598879769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: AL AL20370) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MS MS18826) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX TXK3227) | |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2007-07-08 |