| NPI | 1114184363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: CA A108539) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 242541) |
| Enumeration Date | 2008-05-16 |
| Last Update Date | 2009-08-12 |