| NPI | 1912168238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DC MD042359) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D72021) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101253589) | |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2014-09-03 |