| NPI | 1154397289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MA 208702) |
| Additional Taxonomies | 2084F0202X Psychiatry & Neurology Forensic Psychiatry (Licence: MA 208702) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2011-02-14 |