| NPI | 1043398381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX M4383) |
| Additional Taxonomies | 273R00000X Psychiatric Unit (Licence: TX M4383) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2016-12-14 |