| NPI | 1821383514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D0094427) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD61052896) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 125059742) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 278997) | |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2022-09-08 |