| NPI | 1659439214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: OR MD154059) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX H9007) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2021-03-25 |