| NPI | 1952341968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA 39802) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 43399) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 58239) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2016-02-04 |