| NPI | 1063403921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 213618) |
| Additional Taxonomies | 208VP0000X (Licence: MA 213618) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2011-07-29 |