| NPI | 1629232277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 67504) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MT192870) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD440491) | |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2014-07-07 |