| NPI | 1982915963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 71118-20) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MT198081) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 143287) | |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2019-05-28 |