| NPI | 1003806472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NM NM2003-0024) |
| Additional Taxonomies | 174400000X Specialist (Licence: NM 2003-0024) |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2014-09-16 |