| NPI | 1023208675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA MD.204069) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA GETP.LSU.P) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2011-11-03 |