| NPI | 1811148380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 52153) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA 44855) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 55305-20) | |
| Enumeration Date | 2008-10-02 |
| Last Update Date | 2019-02-04 |