| NPI | 1609895796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 20715) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 31952) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 20808) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2019-08-27 |