| NPI | 1841279601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD179433) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2003008020) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 04-32929) | |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2017-02-09 |