| NPI | 1700860152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD27305) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 220243) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A79761) | |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2009-02-09 |