NPI | 1205989555 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 203650) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD022360E) |
Enumeration Date | 2007-01-19 |
Last Update Date | 2011-03-09 |