| NPI | 1740575646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 1.053938) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 2084P0800X) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2015-08-14 |