| NPI | 1215909585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NV 15797) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME117433) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C54873) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2015-10-03 |