| NPI | 1831379031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NY 258758) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: GA 057961) |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2013-12-19 |