| NPI | 1063542967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD440701) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD doo67752) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DE C1-0009561) | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2011-05-16 |