| NPI | 1669684460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD434864) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 22599) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 22599) | |
| 207Q00000X Family Medicine (Licence: PA MD434864) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2016-12-28 |