| NPI | 1205867637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CO 23169) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: ME 011844) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA A22153) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2007-07-08 |