| NPI | 1700859238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX Q7026) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD419196) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2022-05-16 |