| NPI | 1790766608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: IA MD-35329) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 35329) |
| 2084B0040X Psychiatry & Neurology Behavioral Neurology & Neuropsychiatry (Licence: IA MD-35329) | |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2019-05-20 |