| NPI | 1699764688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX N5875) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: ME 016849) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2018-09-13 |