| NPI | 1699062612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DC MD043185) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT200509) |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2016-07-18 |