| NPI | 1679698559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AR E-7473) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2003018935) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 43147) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2013-06-06 |