| NPI | 1194940130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WI 23168) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NE 14564) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2008-01-22 |