| NPI | 1801186903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: AZ 50605) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX Q4821) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: VA 0101259645) | |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2016-09-28 |