NPI | 1124155791 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA not yet applied) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA not yet applied) |
Enumeration Date | 2007-02-28 |
Last Update Date | 2014-01-13 |