| NPI | 1134299407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OK 24098) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OK 24098) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2010-05-14 |