| NPI | 1750393104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NE 18410) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX H4517) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2015-09-09 |