| NPI | 1851366314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WY 6273A) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 13281) |
| Enumeration Date | 2006-02-20 |
| Last Update Date | 2020-09-30 |