| NPI | 1912109505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 70838) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY P44544) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 0800304) | |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2019-03-22 |