| NPI | 1902062896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TN 0000048115) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: VA 0101251653) |
| Enumeration Date | 2008-07-31 |
| Last Update Date | 2013-12-31 |