| NPI | 1720033376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WA MD60480708) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: UT 8526911-1205) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2018-03-17 |