| NPI | 1750445003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D31740) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DC MD30319) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101055912) | |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2011-11-10 |