| NPI | 1700984127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 11948) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WY 7555A) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MT 10612) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2012-02-02 |