| NPI | 1881751204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0805X (Licence: MA 230640) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 230640) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX N8523) | |
| 2084P0805X (Licence: NM MD2012-0864) | |
| 2084P0805X (Licence: TX N8523) | |
| 2084P0805X (Licence: KS 04-43144) | |
| 2084P0805X (Licence: DC MD044042) | |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2024-05-14 |