NPI | 1972911410 |
---|---|
Entity Type | Individual |
Gender | N/A |
Sole Proprietor ? | No |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 52526) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY R3415) |
Enumeration Date | 2014-07-29 |
Last Update Date | 2019-12-17 |