| NPI | 1124196845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MT 11196) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD60191799) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2015-04-01 |