| NPI | 1740212794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D63509) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101238657) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA MD016794) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 200400595) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2007-07-08 |