| NPI | 1629060314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: PA MD-069582-L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD-069582-L) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2022-11-15 |