| NPI | 1952344483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MS 26167) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 39303) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101265228) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2018-10-17 |