| NPI | 1144455353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: PR 3030) |
| Additional Taxonomies | 273R00000X Psychiatric Unit (Licence: PR 3030) |
| Enumeration Date | 2009-05-18 |
| Last Update Date | 2009-05-18 |