| NPI | 1730151671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 036187) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 30981) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AL 21244) | |
| Enumeration Date | 2006-02-05 |
| Last Update Date | 2012-10-19 |