| NPI | 1790799716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: AK 3995) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 3995) |
| 103T00000X Psychologist (Licence: AK 3995) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2016-10-07 |