| NPI | 1760478861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 16201) |
| Additional Taxonomies | 2084P0805X (Licence: AZ 16201) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2014-04-25 |