| NPI | 1104842988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WI 36974-020) |
| Additional Taxonomies | 2084P0805X Psychiatry & Neurology Geriatric Psychiatry (Licence: WI 36974-020) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2016-09-23 |