| NPI | 1629006507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME82344) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 27723) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2019-01-23 |