| NPI | 1851531982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX Q5232) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY TP385) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY R2301) | |
| Enumeration Date | 2009-03-02 |
| Last Update Date | 2021-10-22 |