| NPI | 1215975099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G136688) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 39563) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 48510) | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2017-04-25 |