NPI | 1003817925 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 18329) |
Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: WI 18329) |
2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: WI 18329) | |
Enumeration Date | 2005-08-02 |
Last Update Date | 2014-08-01 |