| NPI | 1790747673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D30179) |
| Additional Taxonomies | 2084P0805X (Licence: MD D30179) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2007-07-13 |