| NPI | 1962445940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD041390E) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA MD041390E) |
| 103TP0016X Psychologist, Prescribing (Medical) (Licence: PA md041390E) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2020-07-24 |