| NPI | 1053396945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084F0202X Psychiatry & Neurology Forensic Psychiatry (Licence: MA 33392) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MA 33392) |
| 2084P0805X Psychiatry & Neurology Geriatric Psychiatry (Licence: MA 33392) | |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2007-07-08 |