| NPI | 1013005495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 29076) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 29076) |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: SC 29076) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2019-09-17 |