| NPI | 1801845870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD27995) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD27995) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AL 00026322) | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2013-08-29 |