| NPI | 1821063983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 86919) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD061121L) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2022-09-12 |